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Director Payer Contract/Credential

NCHS-MANAGED CARE CONTRACTING Florida-Miami-NCHS Corporate Headquarters Miami, Florida Requisition ID 23676

Description

Job Summary

Responsible for technical and professional payer contracting, credentialing, and pricing for the entire Health System. Provide  guidance and support to Senior Leadership in aspects of payer contracting/negotiations, pricing, and delegated credentialing for the Health System. Responsible for pivoting and adapting NCHS to an everchanging payer landscape and reimbursement structure. Be a role model and leader to subordinates and develop a strong educated and impactful team bench.

Job Specific Duties

  • Responsible for detailed understanding of health care industry, market dynamics, trends, competitors, regulations, and payer environment. 
  • Collaborates with the management team and all departmental levels on both the hospital and physician sides.  Ensure operational issues are addressed and remedied through negotiation, project planning, or contract modification. 
  • Creates and maintains professional relationships with payers and potential affiliates. 
  • Creates, analyzes, and interprets financial reports to support payer negotiations, trends, and audit. 
  • Implements and communicates contracting strategies in collaboration with  Senior Leader.
  • Manages all out of network contracting for both hospital and employed physicians. 
  • Responsible for the management and development of subordinates. 
  • Knowledge and willingness to support new value based transformational contracting strategy at the right time in the right setting.
  • Provides direction, feedback, and recommendations on trended payer performance; serves as the SME for all payer related contractual arrangements/issues- current and historical. 
  • Responsible for overseeing the management of all in network and out of network contracting and negotiations for the hospital and employed physician group. 
  • Responsible for making high impact decisions steeped in judgment. 
  • Develop and lead Joint Operating Committee meeting with payers and respective NCHS departments. 
  • Complies with legal and regulatory compliance requirements. 
  • Leads and oversees Corporate Pricing function. 
  • Leads and oversees Corporate Credentialing function.

Qualifications

Minimum Job Requirements

  • Bachelor's Degree Business Administration or Health Management
  • 4-7 years Management experience in the healthcare finance/payer/managed care contracting field
  • 7-10 years Hospital and/or payer negotiations and analysis experience

Knowledge, Skills, and Abilities

  • MBA or MHA preferred.
  • Work well under immense pressure with an ability to focus on multiple priorities while maintaining focus, attention to detail, and connecting all the dots.
  • Demonstrated leadership progression.
  • Knowledge of fee for volume and fee for value reimbursement methods.
  • Strong contract review and interpretation skills.
  • Familiarity working with Lawyers and interpreting statutes and regulations.
  • Business acumen and strong financial skills.
  • Excellent written, oral, and communications skills.
  • Success in persuasion, influence, and negotiation skills.
  • Management expertise, strong knowledge of data analysis, and statistics.
  • Able to handle day to day administrative routine, as well as, constantly changing, competing projects,  urgent situations, sometimes simultaneously.
  • Able to relate cooperatively and constructively with payers and co-workers.
  • Effective communicator with a strong, transparent, and clear style; ability to deliver tough messages with tact.
  • Effectively monitor and develop the abilities of subordinates.
  • Able to maintain confidentiality of sensitive information.
  • Knowledge of payer and hospital credentialing function.
  • Ability to interpret, adapt, and react calmly under stressful conditions.
  • Ability to analyze and interpret complex models and apply to business ask; strong spreadsheet skills.
  • Ability to use logical & scientific thinking to interpret technical data and solve a broad range of problems.
  • Able to relate cooperatively and constructively with medical staff, executives, staff, elected officials, and managed care companies.


Job :

Management

Primary Location :

Florida-Miami-NCHS Corporate Headquarters

Department :

NCHS-MANAGED CARE CONTRACTING-1000-900910

Job Status


:Full Time
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Joining a new organization can be daunting or overwhelming. But at Nicklaus, your colleagues make you feel welcomed. They taught me to celebrate our accomplishments and band together during challenging times. This is not easy to find in healthcare these days, so I’m grateful to have found an amazing place to work with people and leadership who have my well-being in mind.

Lova Renee Brunson Manager Accreditation & Regulatory

Collaboration leads to success.

Alone we can do so little; together we can do so much. Working together, we find solutions and methods we would never find alone, and at Nicklaus Children’s, we have fun doing it.

Responsibility drives us.

We all take responsibility here – for the children, their families, our work and each other. We meet our responsibilities head on and motivate each other to succeed.

Empower yourself, help others.

Nicklaus Children’s encourages team members to believe in their ability to affect positive change in the world through everything they do with us.

Advocate for the right way.

Advocate for children. Advocate for families. Advocate for yourself. But most of all, advocate for getting the job done right and you will find nothing but success and support in your career here.

Transformation is growth.

At Nicklaus Children’s, change is not to be feared. When you work here, you are always working with the most advanced tools and procedures available.

Empathy is everything.

We expect our team members to have empathy for the patients and families they treat, and in turn, we have empathy for them. We take care of everyone in the Nicklaus Children’s family with competitive benefits and our supportive culture.

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As champions for children, Nicklaus Children’s is committed to putting the health and safety of our patients, families, medical staff and employees first. With the increasing number of adults and children in our community experiencing illness from the coronavirus and its variants, our course of action is clear. Vaccination offers proven protection against severe COVID-19-related illness. All members of our team are required to be fully vaccinated against COVID-19. Accommodations are being made for those who have a medical reason where they cannot receive the vaccine or have a strongly held religious basis for not obtaining it.

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